Laserfiche WebLink
� . . <br /> Apr-30-2002 0 :l0am From-CITY OF ORONO +g522494616 T- 34 P.004/00T F-474 <br /> t <br /> + APPLICAT(ON FOR UTIY.I'rY'PERMiT <br /> CI'TY OF OR NO SI;�g�µ�ATER <br /> Box 66 (2750 K lley Parkway) <br /> Crystal B�y, 55323 <br /> GENERAL INF ATIO <br /> 1. You may pply for utiliry permits by mail or in person at the Ciry offices. <br /> 2. Mailed in plications are subject to the postage atid handiing fee shown below. Pcrrnit cards will sent by return mail che same day <br /> the applic�tion is receivad. <br /> 3, Permits a e aot valid antil yoa receive s permit csrd. <br /> 4, Work mu t not begin unless the permit card is available on rhe job site. � <br /> 5. Utiliry co ection permiu may be issued w licensed contrac:tors only. <br /> 6. Contacc e Public Works Depanment(952-249-4600)for utiliry stub as-built locations. DO NOT E CAVATE IN ANY SZ1tEET AND <br /> DO NOT fiAP ANY MAIN v�+itl'►out express approval of the Public Works Deparnnenk Issuance of permit dces not grant tfnis approval. <br /> 7. All work ust be done in accordance witts State Code requiremenu. <br /> g. Ali work I ast be inspectsd before it is covered. 2��(o�T»otice equired. <br /> JOB SYTE A1 RESS: �6� �E� � Commercial <br /> Occupancy T e: �Residential �� <br /> Owner's N�m : 01�9 �1 v tfl � o^➢ Phone Number: 3 � S9- l�� <br /> MailingAddr ss: Z Za [.AeKo�� L N� o�.Th City: Pzy�u-�-� Zip: S �g7�, <br /> Contractor's ame: PL AS 1Nc�i2.Po2.�"C'�-� _ PhoneNumber: 6S1 - � <br /> Mailing Addr s: I 4 Z Z G Lp c.�s-r ►'�+q-�� _ City:.I'F-� w�u ta Zip: s o 6� <br /> PERMIT TY F $ 5 O c� <br /> Manicipal Se er Connection ($35.00 per stub) <br /> pipe si�e�,^inches; material. i/Sck�edule 40 air tested; ast iron <br /> SAC Charge( 002 rate$1,200.00)must accompany all sewer permit applications unless repaid. If not prepaid,a sewe� <br /> connection pe 't will not be issued. <br /> Mwnicipal V'V ter Connection($35.00 per stub) $ <br /> pipe si e inches; material coppNr; other <br /> WATER ME RS must be�picked up and paid for at City HaIL <br /> Water meter� must be set �nd sealed by Orono W$ter Department (952-249-460 ) upon complefion of inete; <br /> installation. ' <br /> REQU D minimum setbacks from drain field and septic tanks= 75' <br /> REQ D setback from sewer line=20' <br /> pEItNII1'FE � CALCULATIO $ <br /> 1. . Subto of above permit requested $ 5 � <br /> 2. State. urchar e <br /> 'Ihe Sta Building Code Division Surcharge of S_50 per��ermit must be <br /> include for each well,sewer and water connection permlt requasted. <br /> 3. P sta &Handlin (Only mail-in applications) $ 1• <br /> 4. TOT PERMIT FEE(add lines 1-3 above) � 7• v <br /> The undersi ed hereby applies to the City of Orono for issuance of a Utility Permi agrees to do all work in stri� <br /> accordance th the ordinances of the City and the regulations of the State of Minnesot and certifies that all statemen <br /> made on this pplication are completc, true and coaect. <br /> Si�nature of pplicant: Da�' Z <br />